Ratios of Calcium to Citrate Administration in Blood Transfusion for Traumatic Hemorrhage: A Retrospective Cohort Study
Recommended Citation
Alghanem H, Liu NC, Gupta A, Liao C, Wool GD, Rubin DS, and Carll T. Ratios of calcium to citrate administration in blood transfusion for traumatic hemorrhage: A retrospective cohort study. Transfusion 2024
Document Type
Article
Publication Date
11-1-2024
Publication Title
Transfusion
Abstract
BACKGROUND: Massive transfusion with citrated blood products causes hypocalcemia, which is associated with mortality. Recognition of this problem has led to increased calcium administration; however, the optimal dosing is still unknown.
STUDY DESIGN AND METHODS: This retrospective, single-center study included level 1 trauma patients in 2019 and 2020 who underwent an operation within 12 h of arrival and received a transfusion. Preoperative and intraoperative administrations were totaled to calculate the ratio of administered calcium to the number of blood transfusions for each patient. The citrate content of each blood component was estimated to calculate a second ratio, the ratio of administered calcium to administered citrate. Receiver Operating Characteristic (ROC) curves were performed on both ratios to determine the optimal cutoff values for predicting severe hypocalcemia (ionized calcium1.35 mmol/L) at the end of the intraoperative period.
RESULTS: A total of 506 trauma activations were included, receiving a mean of 17.4 citrated blood products and 16.3 mmol of calcium (equivalent to 2400 mg of calcium chloride). No ratio was statistically significant in differentiating severely hypocalcemic patients from the rest. A calcium to blood ratio of 0.903 mmol of administered calcium per citrated blood product differentiated hypercalcemic patients from the rest.
DISCUSSION: Quantifying received calcium and citrated blood products was insufficient to predict severe hypocalcemia, suggesting other contributions to hypocalcemia. We demonstrated an upper-limit ratio for calcium administration in traumatic hemorrhage; however, further studies are required to determine what calcium dosing regimen results in the best outcomes.
Medical Subject Headings
Humans; Retrospective Studies; Male; Female; Hypocalcemia; Middle Aged; Adult; Calcium; Wounds and Injuries; Hemorrhage; Blood Transfusion; Citric Acid; Hypercalcemia
PubMed ID
39351914
ePublication
ePub ahead of print
Volume
64
Issue
11
First Page
2104
Last Page
2113
